Davener’s dermatosis: a unique presentation of frictional hypermelanosis
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Allison Kowalski
A 15-year-old male presented to the dermatologist in June 2023 with a concern of discolored patches overlying his lower spine that presented 6 months prior to examination. He denied any cutaneous symptoms such as pain, pruritus, or burning, and denied any previous trauma or recent medication changes. Past medical history was non-contributory. A physical examination demonstrated two well-defined ovoid hyperpigmented patches overlying his lumbar spinous processes in a linear distribution (Figure 1). The patient admitted to leaning against a rigid backrest during at-home studying. Based on the history and physical examination, a clinical diagnosis of Davener’s dermatosis was made. No further treatment or biopsy was required. The patient was provided counseling and reassurance on the benign nature of this pigmentary disorder.
Two well-circumscribed hyperpigmented ovoid patches overlying the lumbar spinous processes with two horizontal linear striae rubra.
Davener’s dermatosis is a unique form of frictional hypermelanosis, a benign condition that causes increased pigmentation along the spinous processes of the inferior spine [1]. This condition is thought to be caused by increased friction to the lower back, first named by Naimer et al. [1] after the term “davening” (synonymous with ‘praying’) when they discovered this hyperpigmentation in multiple patients who spent hours swaying in wooden chairs praying. Davener’s dermatosis typically presents with a midline, hyperpigmented patch oriented vertically along the inferior dorsal vertebra with ill-defined borders [2]. It can either present in a continuous or cobblestone pattern. The histopathology of this condition demonstrates hyperkeratosis and basal hyperpigmentation of the epidermis [1], [2], [3]. This form of hypermelanosis is not associated with trauma and is commonly asymptomatic in patients with a lower body mass index (BMI) who spend hours seated with ridged backrests [1]. Clinical differentials for circumscribed hyperpigmentation should include postinflammatory hyperpigmentation, macular amyloidosis, Becker’s nevus, fixed drug eruption, and cultural practices such as cupping [2, 4, 5]. Disorders of diffuse, linear, and reticulate hyperpigmentation can be a cutaneous manifestation of genetic syndromes, metabolic disorders, sclerodermoid disorders, and nutritional deficiencies [6]. A clinicopathologic correlation with a thorough history, review of systems, skin biopsy, and relevant labs may help distinguish any underlying condition. While the mainstay of treatment for frictional melanosis is avoidance of the trigger, other modalities can be considered such as chemical peels, hydroquinone, and Q-switched lasers such as Nd:YAG [3, 5]. This condition highlights the importance of a thorough patient history when reaching an accurate diagnosis.
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Research ethics: Not applicable.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: None declared.
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Research funding: None declared.
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Data availability: Not applicable.
References
1. Naimer, SA, Trattner, A, Biton, A, Avinoach, I, Vardy, D. Davener’s dermatosis: a variant of friction hypermelanosis. J Am Acad Dermatol 2000;42:442–5. https://doi.org/10.1016/s0190-9622(00)90216-0.Suche in Google Scholar PubMed
2. Kim, BD, Chung, WS, Lee, SJ, Lee, SH. A case of Davener’s dermatosis: a variant of friction hypermelanosis. Ann Dermatol 2004;16:173–5. https://doi.org/10.5021/ad.2004.16.4.173.Suche in Google Scholar
3. Holzer, D, Wanat, K, Lalor, L. Frictional melanosis: a pediatric case series. Pediatr Dermatol 2021;38:1345–6. https://doi.org/10.1111/pde.14711.Suche in Google Scholar PubMed
4. Vashi, NA, editor. Cultural practices and dermatoses. Cham, Switzerland: Springer; 2021.10.1007/978-3-030-68992-6Suche in Google Scholar
5. Cho, S, Lee, SJ, Lee, JH, Cho, SB. Treatment of Davener’s dermatosis using a 1064-nm Q-switched Nd:YAG laser with low fluence. Int J Dermatol 2012;51:1394–6. https://doi.org/10.1111/j.1365-4632.2010.04787.x.Suche in Google Scholar PubMed
6. Chang, MW. Disorders of hyperpigmentation. In: Bolongia, JL, Jorizzo, JL, Schaffer, JV, editors. Dermatology, 4th ed. Philadelphia: Elsevier; 2018:1115–42 pp.Suche in Google Scholar
© 2024 the author(s), published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
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Artikel in diesem Heft
- Frontmatter
- Medical Education
- Original Article
- Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective
- Neuromusculoskeletal Medicine (OMT)
- Original Article
- Investigating Fryette’s mechanics in computed tomography scans: an analysis of vertebrae spinal physiology using open-sourced datasets and three-dimensional vertebral orientation
- Review Article
- Effect of manual manipulation on mechanical gait parameters
- Obstetrics and Gynecology
- Original Article
- The impact of prepregnancy body mass index on pregnancy and neonatal outcomes
- Public Health and Primary Care
- Original Article
- Associations of clinical personnel characteristics and telemedicine practices
- Clinical Image
- Davener’s dermatosis: a unique presentation of frictional hypermelanosis
- Letters to the Editor
- Fostering a research culture in osteopathic medical education
- Response to “Fostering a research culture in osteopathic medical education”
- Corrigendum
- Corrigendum to: A superficial dissection approach to the sphenopalatine (pterygopalatine) ganglion to emphasize osteopathic clinical relevance
